Medicine: Specialists in the Funny Bone
Hadassah’s troupe of comic healers makes the rounds among the chronically and terminally ill, bringing laughter and a little joy into the hospital.
Forget Coco the Clown and think Charlie Chaplin, Buster Keaton and Groucho Marx—although they seem just as much a stretch as Coco from actively fighting fear, pain and sickness. “That’s because they’re cinematic clowns, not medical clowns,” explains Dudi Barashi (Dudon to his patients), one of six jesters who work at the Hadassah–Hebrew University Medical Center at Ein Kerem. “But it’s in their tradition of comedy that we follow, generating action around ourselves, not using the slapstick of the circus clown.”
“I take off my red clown’s nose and put it on doctors, and they seem less fearsome to young patients,” says Jerome Arouche (Jerome is his nom de clown). “I pretend to examine youngsters using my feather duster or bubble-blower as a stethoscope.”
Much as they clown around, Hadassah’s medical jesters are profoundly serious about their work. “There’s nothing as serious as knowing how to make a frightened or suffering child laugh,” says Barashi. “We start out with a built-in plus: A clown in a hospital is a joke in itself. In our oversize clothes and enormous shoes, our red clown’s nose and big flowers in our lapels, we are the spirit of humor, a reminder of joy and hope in rooms of fear and sickness.”
Although medical clowning as a profession is new to Israel and scarcely more than a decade old in Europe and the United States, it has venerable roots. Court jesters soothed monarchs in medieval times, and 17th-century physician Thomas Sydenham recorded that “the arrival of a good clown exercises a more beneficial influence upon the health of a town than the arrival of 20 asses laden with drugs.”
Created as a paramedical profession in the 1990’s, the art was brought to Israel by Hadassah in September 2002 in the form of three medical clowns. Today, about 30 work in nine Israeli hospitals, interacting individually with acutely and chronically ill children as well as with their families and the medical staff who care for them. At Hadassah, they have recently begun working with adult patients as well.
“When we began at Hadassah three years ago, neither staff nor patients knew what to make of us, whether to tolerate or ignore us,” Barashi recalls. “We were Israel’s first medical clowns and even we couldn’t be sure the clown program would work.”
Within months, however, the jury was in. Doctors now eagerly usher the clowns into their departments and the hospital cafeteria refuses payment for the clowns’ meals because they do holy work.
“The atmosphere throughout Hadassah has become tangibly lighter and happier,” says Dr. Shlomo Mor-Yosef, director general of the Hadassah Medical Organization. “Young patients are more confident and cooperative and medical staff consequently less harried.”
“They come to seriously ill patients, disconnected from their everyday life by challenging long-term treatments, and bring smiles to their faces,” adds Dr. Shimon Slavin, head of bone marrow transplantation and cancer immunotherapy at Hadassah; he recently invited the clowns into his department’s isolation rooms. “They form a bridge between the sterility of the hospital and the brightness of normal life.”
Everyone involved with the clowns has stories to tell. A pediatrician was losing the battle as he tried to measure a squirming, screaming toddler. A nurse summoned Shlomi the Clown (aka Shlomi Golan), who understood the situation at once. He produced a retractable tape measure (one he more usually mimes as a mobile phone) and began measuring the doctor while the doctor measured the child, aping the physician’s every move. Soon the child was laughing.
Arouche, apprised of a 6-year-old patient who refused to eat, produced a collection of rubber animals. “They are yummy!” he told the child, pretending to eat one. “Let’s have a race and see who can eat the most.” From their competition over the “eating” of rubber animals, the two moved on to real food, and the youngster now eats—when Arouche is there.
On one of his rounds, Daniel Viaud, known as Chris the Clown, walked into the room of a little girl attached to a ventilator. The child lay immobile, her distressed mother beside her. “Without thinking about it, I took a balloon out of my back pocket, blew it up and started twisting it into a dog,” Viaud relates. While he can make balloon animals in his sleep, this time he purposely missed the twists and the balloon soared, burping out of his grasp. The child’s lips quivered, her smile became a giggle and then a laugh—her first in six weeks.
Another time, a youngster due to get an injection ran from the room in terror. Golan ran with him. “We hid around the corner until I suggested we try to sneak back into the room without the doctor seeing us,” recalls the clown. The child agreed, and the two of them crept back and crawled under the bed. Then Golan whispered, “Watch me!” and climbed onto the bed. “O.K.!” he cried. “I’m ready. Give me the shot!” After the youngster administered a make-believe injection, the child climbed onto the bed next to the clown and told the doctor, “O.K.! I’m ready!” And he was.
Speaking mostly gibberish mixed with exaggerated mime and facial expressions and using props such as bubbles, balloons, toys, whistles and mini-accordions, the clowns communicate easily and humorously. Sensitive and responsive, they take their cues from the patients as to how gentle or boisterous to be, or whether to visit at all. This allows patients a rare sense of control.
“The clowns have had an extraordinary impact on youngsters throughout the hospital,” says Dr. David Branski, head of pediatrics. “They help acutely ill children lose their fear of hospitalization and treatment and forge a deep connection with chronically sick youngsters, however withdrawn and hard to reach.”
“Unlike medical staff, we go to patients only if they want us,” Arouche explains. “Sometimes it takes days. We hover on the threshold of the room until they indicate we’re welcome. Sometimes children are frightened of us. Then we pretend we are more frightened still, cowering and peeking out at them until we get a smile.
“I stopped by the doorway of a room where an 18-month-old lay in a crib,” he relates. “I only learned later that she’d stopped walking two weeks before. She looked at me. That focus is very important with a young child. Once you have it, you can use music or movement to start play. I looked at the feather duster I carry. Her eyes followed. I waved it, and she followed with her eyes. I raised it, and she pulled herself upright against the crib bars. I heard her mother gasp. ‘Make her walk!’ she whispered. I trailed the feather duster around the outside of the crib and the toddler walked around the inside, in pursuit. It was just a feather duster, but for the mother, seeing her child walk again, it was as if I’d waved a magic wand.”
Barashi, 27, like many of Israel’s medical clowns, has a background in theater. Clowning in street theater and on stage since he was 15, he went on to formal study with Avraham Dana, the man who brought medical clowning to Israel. Viaud, 44, is artistic director of the Magi Foundation, Israel’s professional association for clowns, and an award-winning stage magician. He started out in stage magic, added clowning to his repertoire in courses and workshops outside Israel and specialized in hospital clowning in Israel’s second training course. Arouche, 35, spent 15 years in performance, street and community theater and informal education in Israel before qualifying in hospital clowning at drama school in France. Last year, Magi honored him as Israel’s Clown of the Year.
Professional qualifications, however, are not enough to succeed in a hospital. “You need multidimensional listening skills and intense empathy with people,” says Arouche. “When I look into a patient’s eyes, I see the person. I don’t even think about the illness….”
Inevitably, the clowns become attached to the children they work with—and inevitably, some of these children die. “The first time a child I worked with died, I didn’t know what to do,” says Arouche. “I went to the pediatric head nurse with my shock and sorrow. She was very matter of fact. ‘There’s a little girl in Room 12,’ she told me. ‘Go and see her. She’s waiting for you.’ That’s how I learned to cope. Some patients will die, most will live and we can help many of both.”
Earlier this year, four of Israel’s clowns took the healing power of humor to 50 traumatized young Buddhists and Muslims at Khao Yai on Thailand’s tsunami-ravaged Andaman coast. “Although they were between 18 to 26, they were so emotionally raw it was like working with children,” says Barashi, who took part in the joint Thailand-Israel embassy and American Jewish Joint Distribution Committee project.
“We first met them at lunch,” he recalls, “when we dressed as chefs to serve their food. We thought they’d find that funny, but they didn’t laugh at all. The place was full of flies and my colleague Alex Gruber began asking whether they wanted rice with flies or without. They found that hilarious, and we knew then that we’d found a way across the cultural and linguistic boundaries.”
Running daylong workshops for a week, the clowns’ aim was “to massage the soul…to show that no matter what has happened, you can always return within yourself to places of joy, if only for a few moments,” says Barashi. “We built a program of improvisations and group games, adapting it to the energy level of the group. At the end of each session, we’d all run across the room together shouting ‘tsunami!’ It was a catharsis. It converted the catastrophe they had experienced into something they could handle.”
Progress was gratifyingly rapid. “They all hugged us when we left,” says Barashi. “They said good-bye in Hebrew. They said we’d shown them how to laugh again.”
Clowning, explains Arouche, is “a way of life. We don’t play at being clowns. We are clowns. It’s not so much a technique as a desire to bring pleasure and joy. What goes on in our lives outside the hospital doesn’t matter when we’re at work. We may have come from a funeral, from domestic chaos…but the moment we walk into Hadassah, a mental switch flicks on and we think of our patients.”
It’s not an easy profession to practice. “Medical clowns must be ready for whatever comes up,” says Barashi. “The situations we encounter are often very difficult—patients with cancer, severe burns, incurable illnesses. Our job is to separate them from their pain and take them to a different place, a fantasy place.”
“You know you’ve succeeded,” says Arouche, “when you get a smile or laughter. When you take someone out of pain…even for a few minutes, you are totally renewed.”